There’s another key point regarding the “young vs. old” and “well vs. sick” question that some have raised. The push-and-pull between those more likely to need services soon and those less likely to need them, is fundamental to all insurance and always has been. I’m guessing that many of our friends take good care of themselves and as a result have lower than average healthcare costs. Some may have hardly any at all. Personally, I’m fortunate to be in that category. But the fundamental social compact at the basis of all insurance, as well as the tradeoffs that we see in PPACA, embodies an arrangement in which all pay in, and those who need the services receive coverage as needed. If I need fewer services and someone else needs more, that’s something I can accept as part of citizenship.
How can this be just? Because any of us might get badly injured or very sick at any time, even those with healthy lifestyles. That’s part of life. But having to face financial ruin on top of the already profound challenges of serious illness that can befall us at any moment, often without warning (“there but for the grace of God go I”), is something that has for many years been unique to the American system, This stands in stark contrast to all other wealthy and almost-wealthy nations. It also bears repeating that the U.S. is not just a rich nation; it is the richest.
So the idea that the young and healthy should pay much less and the older (especially those approaching Medicare age) should pay much more for insurance (PPACA limits this to a 3:1 ratio, for the first time), and that women should be charged more than men (PPACA makes this illegal, also for the first time) seems to me seriously dysfunctional. The key point is that the young and healthy aren’t going to be young and healthy forever. The social compact of insurance, and of PPACA, involves a cross-generational set of tradeoffs, where justice lies in the fact that unless we die young or in a quick and unexpected trauma, nearly all of us will be on the other side of the equation at some point.
In response to those who sent me harsh comments about the president … I am not here to defend President Obama. This law is not about him; it is about protecting people from avoidable economic catastrophe and attempting to control costs, as well. My concern is with seeking to create a society that better lives up to our aspirations for compassion and justice. Overall, I find the health reform law to be a significant step in the right direction.
Additional note: As a chiropractor, I also want to mention that the provider nondiscrimination policy in PPACA (Section 2706) is not now being interpreted as written in law. This is a problem that can be addressed administratively, but if it is not, it will require legislative fixes or judicial action. Because PPACA is playing out differently in each state, the seriousness of this issue is far more impactful in some places than others. I have written about this here and will update as this evolves.